The 'Relentless Pursuit' of Eliminating Chronic Homelessness

Boise looks to the Pay for Success model

In 1933, as the United States was mired in a historic economic depression, President Franklin D. Roosevelt summed up his approach to stanching the loss of jobs, property and wealth: "Do something. If it works, do more of it. If it doesn't, do something else."

More than 80 years later, economic cycles continue to rip the fabric of American society. At last count in January, there were still nearly 2,000 Idaho men, women and children without a home, 13 percent of whom are considered chronically homeless—meaning they either have a disabling condition, have been continuously homeless for a year or more or have had at least four episodes of homelessness in the past three years.

"How many homeless people is it OK to have sleeping on the street at night? Of course none is the only answer, the only one that we can ever allow," said Boise Mayor Dave Bieter in his State of the City address in September. "This is the time to take on one of our most challenging issues."

The city of Boise has taken Roosevelt's advice to heart in its battle against homelessness, spearheading and funding a myriad of services or programs: the operation of a winter day shelter; the distribution of hotel vouchers; and, in perhaps its most successful partnership, the creation of Allumbaugh House—a crisis and mental health facility where nearly half of the patients identify themselves as homeless.

But Boise's most ambitious effort to date could turn the decision to wipe out chronic homelessness on its ear.

"The first thing you need to know about this is that Councilwoman Lauren McLean really took the lead to help the city get on board with something that's called 'Pay for Success,'" said Diana Lachiondo, director of Boise Community Partnerships at City Hall. "Sure, governments can dream up a million programs that they think are going to work, but what if government instead defined the bottom line outcomes and turned to the service providers to deliver those outcomes."

The most innovative piece of the new model may surprise some Ada County taxpayers: They'll help fund programs to battle chronic homelessness but not until the outcomes have been reached and verified. In other words, a private funder or corporation would pay most of the up-front costs to the service providers and taxpayers won't pay back the funder until success has been achieved—hence, "paying for success."

Boise and Ada County taxpayers and consumers are already pumping thousands of dollars each year into crisis services for chronically homeless men and women. A recent analysis from the Boise City Ada County Continuum of Care indicates anywhere from $38,000 to $84,000 is required for crisis care—primarily at local hospital emergency rooms—in addition to police, fire and paramedic costs. The biggest expense attributed to homeless men and women comes from the Ada County Jail, where the survey indicated an average of $7,000 is required each year to incarcerate a stunning amount of Ada County's homeless.

"I guess that thing that jumped off the page for me was when I visited the Ada County Jail and discovered that of the average 800 people they have behind bars on a daily basis about 100 of them are considered homeless," said Vanessa Fry, assistant director of the Public Policy Research Center at Boise State University. "I also saw data that indicates homeless men and women have longer stays at the jail. I asked myself, 'What's that all about?'"

That question resonated with Lachiondo, who has been Bieter's eyes and ears in a series of community forums and workshops involving service providers for Boise's homeless population.

"I was part of a group that did some of the recent survey work on homeless individuals. Yes, there are very real costs involved, but these are real people, real lives," said Lachiondo. "One of the gentlemen I sat down with indicated he had some mental health challenges. He shared that he had tried to kill himself when he was very young. He shared with me that he had been to the emergency room eight times in the past four months. That instantly tells me that we, as a community have a significant opportunity."

The survey, including similar conversations with homeless men and women, triggered the award of a $100,000 grant to the city of Boise from the University of Utah School of Business Policy Innovation Lab to fund a comprehensive feasibility study that will be conducted by Fry. Its conclusions are expected to be gathered by next spring, leading to a new Ada County Pay for Success model.

"One of the most exciting things about this opportunity is the possibility of attracting significant funding from outside of Idaho," said Lachiondo. "One of Idaho's biggest challenges is that nonprofit programs are all going to the same people and foundations for funding," she said, adding there is a greater appetite among some large U.S. corporations—Goldman Sachs among them—expressing support for the Pay for Success model."

Lachiondo acknowledged large, sustained cash flow is imperative for any long-term solutions for chronic homelessness, but there is also a moral compass sustaining her interest in the Pay for Success model.

"I'm doing this work because while I believe that government can't do everything, we still have an important role to play in complex situations," she said. "Look. This is fundamental to my belief in how society works. I'm a Catholic. Did you see Pope Francis in his recent visits to Cuba and the U.S.? He said, 'Whoever does not live to serve, does not 'serve' to live.' I'm personally informed by that."

Bieter didn't mention Pay for Success by name during his State of the City address but hinted at something big on the horizon.

"Do we have any choice but to be relentless in our pursuit?" Bieter said. "Look, cities in Idaho have very limited resources, so we have to have our own version of a barn-raising. It's going to take a lot of partners, but we're pretty excited about how we're going to do that. You'll be hearing a lot more about it in the next 12 months."